Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital

Abstract Background Despite the benefit of the human papillomavirus (HPV) vaccine in preventing cervical cancer, fewer than half of eligible young women in the United States have initiated the three-vaccine series. Among those who initiate HPV vaccination, large proportions do not complete the three...

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Bibliographic Details
Published in:Vaccine 2011-05, Vol.29 (21), p.3767-3772
Main Authors: Schluterman, Nicholas H, Terplan, Mishka, Lydecker, Alison D, Tracy, J. Kathleen
Format: Article
Language:English
Subjects:
Adherence
Adolescent
Adult
African Americans - statistics & numerical data
Age
Allergy and Immunology
Applied microbiology
Attitude to Health - ethnology
Biological and medical sciences
Blacks
Cervical cancer
Child
Data processing
Electronic health record
Female
Fundamental and applied biological sciences. Psychology
Healthcare Disparities
Hospitals
Hospitals, Urban - statistics & numerical data
Human papillomavirus
Human papillomavirus (HPV) vaccine
Humans
Immunization
insurance
Insurance, Health
Medical sciences
Microbiology
Miscellaneous
Multivariate Analysis
Odds Ratio
Outpatients
Papillomaviridae
Papillomavirus Infections - prevention & control
Papillomavirus Vaccines - administration & dosage
Patient Acceptance of Health Care - statistics & numerical data
patients
Races
Retrospective Studies
Studies
Tumors
urban areas
uterine cervical neoplasms
Vaccination
Vaccination - statistics & numerical data
Vaccines
Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies (general aspects)
Virology
Whites
women
Young Adult
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Summary:Abstract Background Despite the benefit of the human papillomavirus (HPV) vaccine in preventing cervical cancer, fewer than half of eligible young women in the United States have initiated the three-vaccine series. Among those who initiate HPV vaccination, large proportions do not complete the three-dose regimen. Purpose To evaluate racial and health insurance-related disparities in HPV vaccination. Methods We analyzed outpatient claims data for 8069 patients, ages 9–26 years, who had gynecologic visits at the University of Maryland Medical Center outpatient clinic from August 2006 to January 2010. Results Thirty-five percent of our sample initiated the vaccine series, including 91% of those ages 9–13. Only 11% of the sample and 33% of the 9–13 age group completed the 3 dose series. A higher proportion of blacks than whites (38% vs. 32%; p < 0.01) initiated, and 11% and 12%, respectively, of each race completed. Lower age was strongly correlated with uptake. After adjustment for insurance, blacks were less than half as likely as whites to complete the series in all age groups, and had 0.35 the odds (95% CI 0.26–0.46) of adherence. The uninsured had much lower race-adjusted odds than insured groups for initiation, but had similar adherence rates. Publicly insured individuals were more likely than the privately insured to complete all 3 doses. Conclusions Of the population of gynecologic service seekers seen at our university-based outpatient practice clinics, a significant minority initiate but do not complete the HPV vaccine series. More blacks than whites initiate the series, but similar proportions of the two races complete. Lack of insurance appears to be a major barrier to initiation, despite free vaccination programs.
ISSN:0264-410X
1873-2518
DOI:10.1016/j.vaccine.2011.03.032